Lifa Disease: Frictional Dermal Melanosis over Bony Prominences (Clinicopathological Study)

Background: Lifa disease (Frictional dermal melanosis over bony prominences) has been described in Iraq for the first time in 1993, as a new distinctive pigmentary skin condition that followed chronic friction with a body washing agent (lifa) during bathing. Objective: To assess this increasingly common problem where still many doctors unaware about its presence especially in other Middle East countries. Patients and Methods: A case series descriptive study done in Departments of Dermatology-Najaf and Baghdad Teaching Hospitals, between March 2007 October 2008. Full history and clinical examination were done for all patients including Wood’s light examination. Biopsies were taken from 21 patients and sent for hematoxylin-eosin and Congo red stains. Results: Fifty-two (49 females and 3 males) patients with typical clinical features of lifa disease were studied. The mean age of presentation was 27.92 ± 7.58 years. All patients were slim with prominent bones and low body mass index, used lifa vigorously during bathing. Pigmentation was distributed bilaterally and symmetrically over bony prominences. The most common affected sites were: clavicular areas (67.3%) and upper back (42%). Wood’s light and histopathological examinations revealed dermal melanosis. No amyloid deposit was detected by using Congo red stain in any patient. Conclusions: Lifa disease is a common distinctive pigmentary disfiguring problem especially among females. The histopathology showed dermal melanosis, and might be confused with other pigmentary problems like macular amyloidosis.